Q&A: A doctor and physical therapist explain Joel Embiid’s thumb injury and what comes next

The All-Star center tore a ligament in his right thumb. Two experts discuss what that means for him — and the Sixers.

Sixers center Joel Embiid gets the ball stripped by Raptors forward Pascal Siakam and guard Gary Trent Jr., during Game 4.Read moreYONG KIM / Staff Photographer

Published April 25, 2022, 6:21 p.m. ET

The Sixers’ road to the NBA Finals — and a chance at their first title since 1983 — got a bit more difficult over the last week when it was revealed that MVP finalist Joel Embiid tore a thumb ligament in his shooting hand.

The Sixers center is playing through it, as Doc Rivers and others have been quick to point out that the injury can’t get any worse this postseason. But it still will require surgery to heal — and if Embiid had opted for that surgery now, his season would be over. Needless to say, so would the Sixers’ season.

So what is the team left with, now that Embiid clearly is not 100%? How much will this injury limit the big man? Can it really not get any worse? And are there any concerns over longterm issues?

Ahead of Game 5 between the Sixers and Raptors in South Philly, we spoke with two hand specialists — Dr. Andrew Sobel, an assistant professor of clinical orthopaedic surgery at Penn Medicine, and Suzanne Smith Brandley, an occupational therapist and certified hand therapist with NovaCare Rehabilitation — to get a little more information on the kind of injury Embiid suffered.

While neither could speak to how Embiid is feeling or about his recovery specifically, since neither has treated him, they did offer up some thoughts on his condition and what fans can expect moving forward.

“He’s eventually going to need surgery — and definitely therapy after that — since he’ll be stiff from surgery,” Smith Brandley said.

The good news, according to Smith Brandley, is that even with delaying the surgery, there’s no reason to believe that Embiid won’t be back to 100% when next season opens. The bad news is that Sixers fans aren’t looking ahead to next season as the team still is in the hunt in the Eastern Conference, leading their first-round series against the Raptors.

And they don’t need Embiid to be ready by next fall. They need him to be ready now. So what can Sixers fans expect?

How serious is a torn thumb ligament in both the short- and long-term?

Smith Brandley: “A hand therapist would definitely be involved beforehand and after the surgery. Beforehand, there would be taping involved to support the joint of the thumb as well as possibly some splinting as well. A torn thumb ligament is serious because you need those ligaments to keep your thumb stable in all those different planes that your thumb operates in. And those ligaments are what keep your thumb from kind of giving way.

“He tore, it sounds like, the ulnar collateral ligament (UCL) of the thumb, and that ligament keeps your thumb from just spreading even further away from your hand when you go to grasp wide objects like a basketball and gives you that stability when you’re holding wide things. So [surgery] is definitely necessary. It’s going to need to get repaired. It can wait — it’s obviously not the best scenario to wait, but people do wait until the postseason.”

Sobel: “A fully torn ulnar collateral ligament of the thumb can result in pain and instability in the short-term, meaning that the thumb is not stable against which the other fingers of the hand could pinch or grasp. This instability can lead to long-term changes at the joint, which can even result in arthritis if not addressed early. Therefore, we typically recommend surgery to repair the ligament.

“With a fully torn ligament, the earlier the surgery is performed, the more likely it is that the healthy ligament can be reattached to the bone anatomically or stitched together. If left untreated for weeks, the ligament can shorten or contract, which may make the repair harder. Sometimes if the ligament is torn for a long time, fixing it requires a reconstructive procedure where a piece of tendon is taken from a different part of the hand or wrist to create a new ligament.

Is Embiid going to be in constant pain or are there things that can aggravate it?

Sobel: “With thumb ulnar collateral ligament injuries, there can be significant pain, especially within the first few days after the injury occurs. This can affect the function of the hand and athletic performance. For basketball players, this can primarily affect rebounding and ballhandling, but shooting can also be effected.”

Smith Brandley: “There’s going to be some mild discomfort always there. And then any kind of especially unpredictable actions like a ball being thrown hard or stumbling or hitting another player — those things are going to challenge that thumb ligament and the taping and the support provided to him. So those things are going to make it more uncomfortable. He should be fine for shooting, but anything where he’s taking rebounds or hard passes, those things are going to be more challenging.”

Can he hurt it further by playing through it?

Smith Brandley: “There’s always a risk that it could get hurt further, but if the ligament is completely torn, then it’s torn. But I’m sure that he’s going to have a good hand therapist assigned to him and trainer assigned to him that’s going to be taping that thumb to be very secure and protect it as much as possible, so I doubt that anything more is going to happen to it.”

Sobel: “There are increased risks to further injuring this area of the thumb with continued playing, though these are not very high. To help prevent this, many athletes will have a professional hand therapist wrap or brace the thumb to prevent further injury such as injuries to the other ligaments of the thumb, cartilage, or bones themselves.”

Are there any risks to delaying surgery?

Sobel: “As previously mentioned, delaying surgery can make the repair a bit more difficult, or even lead to the need for a reconstructive procedure. Many athletes make the decision to delay surgery if they are in critical portions of their season or career. Still, the outcomes from a reconstructive procedure, while a bigger procedure, are often very good as well.”

Smith Brandley: “Repairing things quickly is always ideal. With ligaments, they start to shrink as time passes if they’ve been injured or if they’ve been torn. And, you know, there’s a chance that they’re not going to be able to just repair the ligament, that they might need to use a piece of tendon to reconstruct the ligament or make a graft for it. So it’s always best to repair it right away, but with where they are in the season right now and him being such a great player — and necessary — they’re going to have to wait. And then when [doctors] get in there, they’ll see how much ligament length they have to work with and what surgery is going to be necessary.”

Will it get any better this postseason? Or will he just get used to it?

Smith Brandley: “For most athletes, that happens. They develop compensatory techniques and strategies while they’re playing, so I imagine his discomfort will decrease, but the ligament itself won’t heal without surgery. But I’m sure he’s going to handle the ball a little bit differently; he’ll be more careful with some of his motions.”

Sobel: “Once the ligament is torn, if there is displacement (shifting of the ligament away from where it was attached to the bone), the ligament cannot heal back down to the bone because there is too much distance across which it would need to heal. With casting or bracing, it’s possible to prevent the ligament from moving further away from the bone and healing can occur.”

What can he do to limit his pain and the impact on his game?

Smith Brandley: “The taping and the splinting are going to be the most important. But they’ll be doing modalities to decrease the swelling and his pain before and after the games, I’m sure. But the taping and splinting are going to be the most important for sure. ... I doubt they would do any kind of pain injection, but they might consider a cortisone injection just to help him get through the next couple of weeks, but a surgeon or hand doctor would speak better to that.”

Sobel: “To get through the game, athletes can have the thumb professionally taped or wrapped by a hand therapist or athletic trainer. A splint can also be made to help prevent the thumb from deviating into a bad position. Occasionally, athletes will undergo numbing shots to help get through the pain of a game.”